Obamacare

By Sean Carroll | March 22, 2010 10:03 am

Good news and bad news last night, as the House passed health care reform.

The good news is: the House passed health care reform. The work isn’t completely done yet, of course. The House had already passed a heath care bill, months ago, but this isn’t it; last night they passed the Senate’s version of the Bill, which had some glaring flaws. Under ordinary circumstances the House and Senate would get together and hammer out a compromise between their two bills. But in the meantime Republicans picked up an extra Senate seat in Massachusetts after Teddy Kennedy died, and they had promised to filibuster the compromise package. (Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance, especially if that was the life’s goal of the Senator whose death allowed you to improve from having twenty fewer votes than the opposition to only having eighteen fewer votes?)

So Obama will sign the Senate bill that the House just approved, and then the Senate will consider a reconciliation bill also passed by the House last night. Under even-more-arcane procedures, the reconciliation measure can be passed without threat of filibuster. It requires only “majority vote,” a quaint notion in this highly baroque age.

It’s not an especially huge bill, whatever you may have heard, but it will have an impact. Here is a list of the major impacts, and an interactive graphic to figure out how you will be affected. The most important features seem to be:

  • Establish health insurance exchanges, and provide subsidies for people below four times the poverty line.
  • Guarantee insurance for people with pre-existing conditions, and eliminate “rescissions” that take away insurance from people who get sick.
  • Push business to provide insurance for their employees, and self-employed individuals to buy insurance for themselves.
  • Close the “donut hole” in the existing Medicare payout structure.
  • Implement cost controls (mostly through slowing the growth of Medicare spending), thereby lowering the budget deficit by $130 billion over the first ten years, and by another $1 trillion over the next ten years.

Overall, it’s a relatively incremental bill, placing bandages over some of the more egregious wounds in the current system, while leaving in place the essential structure through which we funnel billions of dollars to middlemen while paying far more for medical care per person than any other country without getting better results. For 90% of Americans, coverage and insurance will continue as before. Basically, this brings us a little closer to where Western Europe was a century ago.

Still, a tremendous political accomplishment — maybe not from the perspective of what we were hoping for when Democrats took control of both houses of Congress and the Presidency in 2008, but certainly from the perspective of the last couple of months, when it often seemed like we weren’t going to get anything at all. More than anyone, credit for the accomplishment goes to Nancy Pelosi, who didn’t give up when things looked grim. From now on she won’t simply be known as the first female Speaker of the House, but one of the most effective leaders in its history. Here she is marching to the Capitol yesterday, arms linked with civil-rights pioneer Representative John Lewis from Georgia, carrying the gavel that was used when Medicare was passed in 1965. An historic moment.

Which brings us to the bad news. One of the reasons why Pelosi was marching with Lewis was to demonstrate support a day after this man who had marched at Selma was repeatedly called “nigger” by protesters outside the Capitol. Ugly by itself, but worse in context: it’s becoming harder and harder to have a meaningful debate in this country without participating in a race to the rhetorical bottom.

There exist reasonable arguments against health-care reform; not arguments I agree with, but ones that at least make superficial sense. It costs money to provide insurance for the uninsured, and someone will have to pay. Asking healthy people to buy insurance will be a burden to them. There will be less extra money floating around if we cut down on unnecessary costs, which might impede the pace of medical innovation. (I didn’t say they were great arguments, just that they made superficial sense.) But these aren’t the arguments that are actually made most frequently. Instead we hear that the Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won’t stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny. Right-wing bloggers nod with approval at the idea that people are stocking up on guns, preparing for fighting in the streets. The race to find the most scary and overheated characterization of a pretty benign state of affairs is a fierce one.

The most depressing aspect of the situation is not the existence of crazy fringe elements — those will always be with us, on both sides of any issue — but of the reinforcing dynamic between the fringe and the supposedly respectable parts of the Republican party. It’s been clear for a while to most people (outside the White House, anyway) that Republicans in Congress made a clear choice that their own self-interests are served by preventing Democrats from passing any meaningful legislation, whatever that might mean for the good of the country. Speeches during House “debate” last night consistently played to the worst aspects of the protesting mob. One Congressman shouted “baby killer!” at Democrat Bart Stupak, who is staunchly anti-abortion, as he spoke to support the bill. [Update: it was Randy Neugebauer (R-Tex.).] Two protesters inside the House chamber were arrested for being disruptive — and “several Republican lawmakers stood up and cheered during the interruption.”

Lest you think this is simply concern-trolling from a liberal telling conservatives to be less intrusive, note that conservative commentators like David Frum are making the same point: the rhetoric has gotten out of hand, and it’s not good for anybody, except maybe the “conservative entertainment industry.”

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

I’m not sure what the end game is — whether it’s possible to step back to a more reasonable dialogue. Disagreement is good, and it’s important to have an active and engaged opposition party, no matter who the majority party might be. But whipping up hysteria at the cost of working together constructively isn’t in anyone’s interests. Obama campaigned on a message of hope and change and bipartisan togetherness, and I think that was a sincere message on his part; but it certainly hasn’t come to pass, and there doesn’t seem to be any indication that it will.

CATEGORIZED UNDER: Health, Politics
  • Katharine

    Great.

    On the other hand, I’m faintly nervous about the domestic terrorism that is sure to spring up on the side of the idiots.

  • Braemar

    I do not see any concern about the ability to treat these additional 30 million+, nor for those who will lose the current level of healthcare when businesses drop employees insurance.
    Looks like working taxpayers suffer and those who use tax money without paying are benefitted. Yes, we want to assist those in need, but how much will you do before your own familiy is hurt? Would you pay over half your weekly wage to the government to pay for increased costs of care?
    Also what will happen when adding to these 30 million+ with the next push: immmigration reform. Let’s sink the boat? You drown as well.
    What happened to pilot trial programs in several states to make the best plans? This was not the best way to implement a huge change!

  • Katharine

    Braemar, you’re going to have to cite your sources.

  • G

    Sean, do you really think that Congress will vote to cut the Medicare reimbursement rate this year? If not, then the bill really is a farce in that it will not save us any money and will in fact add (and add big to the deficit). Keep in mind the doctor reimbursement rates were scheduled to drop on March 1st but Congress postponed it until the fall.

  • UchicagoMan

    Yeah, unfortunately, things are really scary with people like that. Domestic terrorism, racist, hate propaganda. Really unfortunate in modern times.

    But, we must stay strong! As Obama says we must have the Audacity of Hope!

    Always remember, we as nation have come from much darker places in the past.

    The Civil Right era, and before that, is an excellent example. People were sprayed with hoses, violently attacked and killed. The KKK used to be a reputable institution in the South. Hell, this country was founded with slavery!

    Yet, the good prevailed. And the good and righteous will prevail again.

    However, it is not without often immense sacrifice. Meaningful change is slow, painful, and requiring of undying endurance.

    But, when one’s heart is filled with the an ocean of strength gained by helping others, you will not run out of strength to fight on!

    Hopefully, non-violent, civil discourse, and cool-headedness will prevail.

    I do believe the hate jabbering can appear louder in the ego-casting, multiplying internet age.

    But people are also better informed and empowered these days. We can counter that BS. And I also like to believe (and hope is true) that for the most part people are only idly threatening violent actions. Voting conservatives into power is non-violent and democratic, so be it. But, threatening elected officials (or those who support them) with racial slurs and forced revolution is not acceptable.

    It is an “absurd universe”(or Preposterous perhaps ;-) ) as Camus proclaims, but we must choose to fight for what we can best construct as ethical and good.

    And importantly, it will not be easy.

    but…

    Yes. We. Can.

    (ok, off soapbox! Cheers everyone.)

  • Katharine

    UchicagoMan, got any advice for someone who is occasionally scared of objecting in anything but the most tactful, placid-sounding terms (although I never agree with them) out of fear of getting beaten to death or possibly shot by one of these people?

    I’m quite capable of doing it wittily, but I keep thinking if I say everything I want to say I’m going to end up in the hospital or in a small urn.

  • Katharine

    If I say everything I want to say about how wrong the conservative idiots are, I mean.

  • Dan

    At this point there is only one way to get a more reasonable dialog out of the conservatives, and that is by this Fall’s elections. My best guess is that conservatives will continue with the divisive inflammatory rhetoric, obstruction in congress, and pandering to their crazy fringe constituents. However, if they have only limited success, if not outright defeat, at the ballot box, they will be forced to rethink their tactics. Perhaps they will realize that to have a constructive voice in our politics is to choose reason and compromise over temper tantrums.

    I strongly encourage everyone to be engaged in politics, talk calmly and intelligently about issues with your friends and family, donate to candidates you like, volunteer for get out the vote drives, and do whatever you think is in the best interest for the entire country.

  • Stephen P

    I was wondering whether to congratulate you on joining the second half of the twentieth century, but then you well and truly pre-empted me.

    The opposition sounds rather like that which the British Labour Party received on starting the National Health Service in 1948. Then it took the Conservative leadership just three years to realise that they’d been making a bad mistake, and that any threat to undo the change would be a huge vote-loser. I wonder how long it will take in the USA.

  • Jeff

    Sean says, “…Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance…”

    Eh? Courage? Morals? Isn’t this all just part of the inevitable sequence of state space transitions predicted by the fundamental laws of physics? (I really liked your book, by the way.)

  • Scott B

    Sad thing is, Republicans saw the divisiveness they created during the Clinton administration as a win. They are simply upping the ante with Obama. Also sad, I think they’ll win in 2010 & 2012 because of it. There’s a lot of rightful anger out there that these tactics tap into. Wish people could see through the BS, but if they could we wouldn’t be where we are now. Not that the Democrats are really the solution to our problems either. The extreme right wing that calls itself the Republican party today is surely not it though.

    About health care, I don’t like much about what I’ve heard about the bill. Anything that leaves our current insurers in place is a failure IMO. They are most of the problem to begin with. Should have just been a system where every citizen is covered. Yes, quality of care for those who have coverage now (like me) would probably go down some. I’m willing to wait an extra week or 2 on an appointment so that some family that couldn’t afford insurance can see a doctor. I’m afraid the “compromise” plan we have now is set up to fail. Half the bad things the Republicans argued against this bill have almost been guaranteed by this plan. The next step, which has already started, will be to tax every unhealthy thing they can think of so we can pay off the insurance companies without doing the politically inconvenient but right thing, raise income taxes (or fix the plan, but that’s not likely). That step will really bother me.

  • Patrick

    First, I think you’re summary and discussion of the bill’s merits is good. That said, it seems a bit hypocritical to complain about conservatives making accusations that “…Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won’t stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny,” when you start off the article by claiming that the motivation of Republicans in congress to oppose this particular bill was “…the fight to prevent millions of people from getting health insurance…” I agree that the discourse in Washington has sunk to new lows, but even Obama, when talking about it, makes it clear that both sides need to clean up their act.

  • Brian

    I’m really disappointed in you, Sean.

    I love this blog and bought your book. Reading your uneducated opinions on health care, health insurance, public entitlements, and the nature of the political debate is upsetting.

  • Scott B

    @Patrick:
    What exactly where the Republicans fighting for then? To keep their insurance buddies happy? That’s much better. To protect the quality of care for the insured? Maybe, by keeping others from getting insurance. To keep government small? Maybe, but then that wasn’t a concern during the previous administration. At least the money now will help a few people instead of just blowing up foreigners.

    @Brian:

    Instead of just claiming Sean is uneducated, why not state why you believe so? It’d probably start a decent debate where a few people might learn something.

  • http://www.kritischdenken.info Jefke

    As a European citizen it ‘s beyond my understanding that there are still (mostly republican) people who are against it. We have these regulations since more than 30 years. I don’t know any single person (not even in the most right-side of politics) that would get rid of it.
    Welcome to the civilized world America! You have a real great president!

  • changcho

    A good, first and large step for the US to become a more civilized country.

  • Gregg

    I agree with your comments. Seems to me your recent book’s title would be an apt description of how long it has taken us to get to even this point in moving toward an improved healthcare system for this country. I realize this is a departure from your usual focus on cosmology but this is your blog. I’m glad you chose to speak your mind. I loved your Teaching Company course on Dark Energy and Dark Matter. Hope you have another sometime in the future.

  • marvin thalenberg md

    My conservative friends are unshakeable in the ideological belief that there is a free market in medical care.Explaining that no one on an ambulance stretcher starts bargaining for the most cost effective hospital does not penetrate.
    What will sink any plan which opens up medical care is that we need a lot more primary care physicians. But we have too few now. The slack has been brought up by importing Asian doctors, but , as in technology, fewer are coming, and some are returning.We have to subsidize medical education so that doctors dont graduate with debts of $120000 and get siphoned off into giving botox.

  • Neal J. King

    Yes, it’s true that the bill is not what we had hoped.

    But non-passage of the bill would have been even less.

    And if you’ve got a stone moving, you can try to re-direct it; but a stone that is sitting still is just not moving.

  • Jeff

    I was just going to make my one my smart aleck remark about determinism…but some of the other comments seem to be compelling me to submit again. ;-)

    Katherine: “If I say everything I want to say about how wrong the conservative idiots are, I mean.”
    Jefke: “Welcome to the civilized world America!”
    changcho: “A good, first and large step for the US to become a more civilized country.”

    Wow. Really, that is how you start a dialog? Or are you rather just making arrogant statements in an echo chamber of folks that all agree with you?

    I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.

  • Katharine

    Well then, Jeff, kindly stay off the road.

  • Tom

    “I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.”

    Do you disagree with the basis of every government on the planet, then?

  • jpd

    Jeff, stay off off the (government subsidized) road and off the (government subsidized) internet

  • Jeff

    @Katherine:

    Sorry, I was trying to state my principle in one line and don’t think I managed it. Roads and other public goods don’t count as redistributing value from one person to another. We can debate what public goods are so necessary as to justify taking resources from citizens to fund them. (You can probably guess that I’d be for keeping the list as short as possible.)

    @Tom:

    My explanation to Katherine might answer your query too…not sure. Taxes in general are problematic to me. But my concern would be reduced if revenue were not used for wealth redistribution and if the size of government were kept small. Given the present size of the US federal government I don’t need to look at the merits of *any* new spending program. I vote no.

    @jpd: See answer to Katherine above.

    @All Three:

    My main point was to define my position as closer to those called uncivilized idiots than with most of the posters on this thread, to see if anyone wanted to call me nasty names too! Perhaps I am just too sensitive, but I see a tendency in supporters of more public spending on health care to consider anyone who disagrees to be stupid, ignorant, or worse.

  • ian

    Yes, roads and public services financed by tax revenue certainly count as redistributing wealth. The government takes money in the form of taxes and redistributes it in the form of services. Anyone can use the road, rich or poor. And if there’s a sidewalk (or you have a bike) then you don’t even need a car. Your theory is contradicted by experiment.

    Many European countries have better healthcare than the US while spending less money on it. This holds true in single payer systems (such as the UK), and countries like the Netherlands and Switzerland that require purchase of private insurance. There’s no reason the US can’t do the same.

    And I doubt anyone, yourself included, reading or replying to this blog is uneducated or unintelligent.

  • hmm

    Aren’t schools in america publicly funded? Does Jeff think that is also wrong?

  • http://blogs.discovermagazine.com/cosmicvariance/sean/ Sean

    As tempting as it might be, this really isn’t the place to debate the fundamental principles of libertarianism. But if you want to talk about health care, go for it.

  • SteveN

    Jeff: “I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends.” Spoken like a true libertarian. Well, here are a few things the “fruits of your labor” support: public schools, community colleges, state universities, police protection, fire departments, trash collection, recycling, water, sewer, parks and recreation, libraries, museums, road construction and repair, traffic safety, mail delivery, Social Security, Medicare, Medicaid, Homeland Security, FEMA, TSA, FAA, FDA, EPS, OSHA, SEC, FDIC, Federal Reserve, Army, Navy, Marines, Air Force, Coast Guard, National Guard, FBI, CIA, NIH,CDC,NSF. Etc. Exactly which services do you wish the “fruits of your labor” not go to someone else?

    SteveN

  • marvin thalenberg md

    We have nearly a million bankruptcies a year -families with health insurance which did not cover costs. Someone asked a Swiss how many medical bankruptcies they had. he said “none- that would be immoral”

  • graham

    Sean,

    There is historical precedent for hyperpartisanship whipped by outrageous rhetoric. Look no further than the bowels — then the Terror — of the French revolution, what happened between the Jacobins and the Girondists. Suggest Simon Schama’s “Citizens” if you haven’t already read it. What happened then is one possible outcome. Self-immolation followed by the rise of an imperial Consulate (Bonaparte) and years of war — self-destruction turned outwards into military aggression.

    – g

  • Eugene

    Sean —

    “Asking healthy people to buy insurance will be a burden to them.”

    I think that’s the whole point of insurance — that you divvy up the risks among a group of people because “one never knows” who is going to get sick. And these group of people include healthy people.

  • JimV

    Jeff, here’s another way to look at it. When people buy health insurance right now, the healthy people are redistributing their wealth to the unhealthy people. I’ve been to a doctor about three times in my life (I get annual checkups by nurse-practitioners at work), and have never had anything worse than a broken nose. If I get run over by a truck tomorrow, all the money I spent on premiums was redistributed elsewhere. Yet I buy insurance because I don’t know that I will never need it.

    A lot of my money went to insurance company personnel who aren’t doctors or nurses. What’s wrong with eliminating the insurance company middlemen, and all insuring each other, through some non-profit, central organization, like, say, the government?

    I realize that’s not what we got in the current bill – because, and forgive me if I’m wrong, people like you derailed all attempts to put in a public option. (If you do support a public option, I apologize.)

    Anyway, I didn’t get my public option, but the numbers I’ve seen, from studies by the Kaiser Foundation, the CBO, and elsewhere, convince me that what I did get is way better than nothing.

  • Brian

    @ Scott B

    I’m sure an educated debate is a waste of time. But here we go…

    The CBO score is meaningless at this point. The CBO follows very strict and well understood rules in scoring a bill. We will most likely not see the cost savings promised and this legislation will not reduce the deficit.

    From the CBO:
    “Those longer-term calculations reflect an assumption that the provisions of the reconciliation proposal and H.R. 3590 are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation. For example, the sustainable growth rate mechanism governing Medicare’s payments to physicians has frequently been modified (either through legislation or administrative action) to avoid reductions in those payments, and legislation to do so again is currently under consideration by the Congress.”

    http://www.cbo.gov/ftpdocs/113xx/doc11379/Manager%27sAmendmenttoReconciliationProposal.pdf

    The well publicized “Doc Fix” is an example of cost cutting in Medicare that never materialized. Doctor reimbursement was supposed to be decreased to make Medicare more financially sound, but every few years Congress returns to the issue and overturns the cuts to Doctors. It’s expected to cost $200 billion over the next 10 years. There is a similar example in this bill too. See Section 1202 of the House reconciliation.

    http://docs.house.gov/rules/hr4872/111_hr4872_amndsub.pdf

    In 2013 and 2014, primary care physicians seeing Medicaid patients will get payment equal to Medicare patients. Medicaid usually reimburses doctors and hospitals less than Medicare because payment is determined by states. Since states share the cost of Medicaid with the government, it’s in their interest to keep Medicaid reimbursements down.

    What do you think will happen in 2015? Will the federal government allow doctor reimbursement to drop back down to Medicaid levels or will this create a new “Doc Fix?”

    The CBO scored this as only $8 billion in new spending because it only lasts two years. But this is a cost that I expect to last indefinitely. And this bill expands Medicaid eligibility to 15 million additional Americans when the meat of this bill kicks on in 2014.

    This is ONE example of awful accounting and manipulation in this bill. I will continue, if the readers here will concede that this is a serious problem and we have been deceived by the Democratic leadership.

  • Tszap

    All the Republican shrieking about this was completely over the top. By the end they sounded like Bucky Katt (http://comics.com/get_fuzzy), spouting inflammatory words (“totalitarian!”) without the slightest regard for what they mean. I have a hard time believing these are elected officials from a serious political party.

  • marvin thalenberg md

    Jeff’s quote
    I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.

    This is theology, and brooks no argument, and makes no sense. it is specially ironic in a cosmologist’s blog. Imagine cosmology without government backing.

  • Brian Too

    Readers of this blog might be interested to know that when Canada passed health care legislation, much the same overheated rhetoric and absurd predictions of calamity were made. None of those predictions came true and the people who voiced them sound parochial, silly and partisan in retrospect.

    For the organized political parties, continuing to oppose what clearly was an overwhelming success, became political hemlock. So they switched positions of course. That’s politics!

  • Jeff

    Sean’s request in #27 means that any responses I might make are out of place here.

  • http://www.shaky.com Timon of Athens

    ” It costs money to provide insurance for the uninsured, and someone will have to pay.”

    No kidding. Never mind, I’m sure that that fabulously wealthy guy, Someone Else, will pick up the tab.

  • Claude

    You all seem to have a lot more trust in the federal government than I do. When I see the spiraling costs of Medicare, Medicaid, Social Security, the US Postal Service, and expanded health care in Massachusetts and Tennessee, I lose all faith in any of the cost estimates that I hear. Everyone loves entitlements until they bankrupt the country.

  • Pingback: 22 March 2010; they got the job done! « blueollie()

  • Brian137

    No kidding. Never mind, I’m sure that that fabulously wealthy guy, Someone Else, will pick up the tab.

    I would be happy to contribute.

    You all seem to have a lot more trust in the federal government than I do.

    The Federal Government is staffed by people, not space aliens. Some do a good job, some not so good. But insurance companies are staffed by people also. Good luck to us all.

  • Braemar

    The point is, how much are you personally willing to contribute when it takes a toll on your own family.
    Imagine you are taking care of your family, it’s needs and also your neighbor’s family. While that may be morally or philosophically attractive, that losses luster as your family is hurt by the loss of income.
    Too many Grasshoppers and not enough Ants. Soon we’ll have the ruling elite and the rest designated workers. Maybe we can all join the ruling elite.

  • Carl Brannen

    At the last physics conference I attended, a physics professor from Canada, in response to my noting that people who exercise a lot seem to always have to go to the hospital, complained about their health system. A tendon snapped near his elbow and a muscle came loose. When he went to the hospital they required him to talk to his “primary health care provider”, rather than go directly to the obvious specialist because Canada’s health care reform has resulted in a shortage of doctors (official Canadian gov. link) Then he would be put on a waiting list; by the time he would be operated on his arm would be permanently impaired.

    In addition, he discovered something that those of us who have worked in the ultrascan industry already knew; Canada’s “MSP” system has no available modern doppler based ultrascan equipment <a href="http://www.canadadiagnostic.com/A5_AboutCDC.phpinstead you have to pay private companies like this one. He had received better care in the Philippines.

    He was so dissatisfied with Canada that he asked his department for a 1 year sabbatical so he could take a job in the Caribbean, (I forget where, was it the Dominican Republic) where he expected to receive better care than Canada.

    Fortunately, some of his former students worked at the hospital and recognized his name. They pulled strings and he was operated on the next morning. The situation reminded him of his experience in the former Soviet block. Yes, adequate (not good) health care remains for people who have connections, but the system runs as badly as any other system run by the government.

    I know people who’ve had wonderful experience with European health care. But I live close to the Canadian border and people regularly come across the border to obtain access to real health care. I know the Canadian system is atrocious.

  • Clifford

    I am very impressed and surprised with this blog entry — a physicist making a political statement, but also one that is highly informative and well-composed. I had no idea any of things were happening just a couple of miles away from my sorry existence.

  • JimV

    Rejoinders:

    This bill reduced health costs. Other bills in the future may increase health costs again. That is true of all deficit-reduction bills (they could all be overturned in the future), and is no reason not to vote for such bills.

    The additional cost of insuring the uninsured comes to about 5 cents on the health-care dollar. At that level I have no us-vs.-them moral quandry. (Note: the uninsured actually do get some of the most expensive kind of health care – emergency care – right now.)

    I have seen more anecdata from Canadians (including a brother who lives in Canada) extolling the Canadian system than otherwise.; and it is a fact that they live longer for less per-capita cost than us, just like the rest of the developed world.

    If people want to get rich quick, they spend four years of college taking courses like “Physics for Poets”, then become investment bankers. My nephew the doctor was never happier than when he was in the Navy, working in a clinic, getting paid a salary and never caring whether his patients had health insurance or not. (He left med school free of debt – the Navy paid his way in exchange for a tour of duty. He got to fly in the back seat of jets, too.) His practice employs more people just to handle insurance forms than doctors and nurses.

    The bill could have been a whole lot better. I personally blame that mostly on Republican obstructionism. A life-long independent, I voted about 40% Republican and 60% Democratic 30 years ago. These days, as poor as many Democrat politicians are, I have difficulty voting for a Republican for dog-catcher (knowing that they voted for GWB twice).

  • Brian137

    Hello Braemar,
    Thank you for responding to my previous post (#41). You said,
    The point is, how much are you personally willing to contribute when it takes a toll on your own family.

    You posit a hypothetical that does not apply to me. As Yogi Berra might have said, “If things were different, they’d be different.” Notice that I made no claim that anyone else would or should be happy to contribute, merely that I would be. I respect the fact that each person has his or her own unique circumstances.

    Imagine you are taking care of your family, it’s needs and also your neighbor’s family.

    You nailed me this time. I do take care of another person, who is not related to me.

    While that may be morally or philosophically attractive,…

    Man does not live by philosophy and morals alone. This may be tough for you to understand, but I very much enjoy helping this person. I think many (most?) of us feel something similar at times. Watch a mother with her child, watch two lovers, watch two friends.

    Too many Grasshoppers and not enough Ants.

    Most of us don’t ultimately aspire to be Ants. I would never disparage Anthood – if you are an Ant, I say be a proud Ant, perhaps even a great Ant. I enjoy a balanced life. I am lucky in that I enjoy my work, but I also like to relax and have fun.

  • Paul Stankus

    When I was a kid growing up, many people in the neighborhood had antique-looking cast iron plaques mounted as decorations to the fronts of their houses. It was explained to us in school that these had originally been fire company logo markers: artifacts of a bygone age when people contracted individually with private fire companies, and each fire company would only douse a fire in your house if you had their marker out front. We were told that, back in that benighted era “a fire truck would go right past your house, even if it was burning, if you didn’t have their marker!” in a tone indicating that this was an uncivilized practice; and that we, now with public fire companies, were rightly proud to be better than that.

    I look forward to a time, maybe within my lifetime, when schoolchildren will be taught that the bygone age when sick people couldn’t always see a doctor was an uncivilized time, and they should be proud to be better than that.

  • Brian

    @ JimV

    Jim V wrote:
    “This bill reduced health costs. Other bills in the future may increase health costs again. That is true of all deficit-reduction bills (they could all be overturned in the future), and is no reason not to vote for such bills.”

    This bill is not about reducing costs. Republicans already proposed doing this piecemeal. If the Democrats had identified ways of cutting costs in Medicare, why not make that a standalone bill and reinvest the savings in the unfunded Medicare liability we already have?

    At its heart, this bill is a new entitlement program. It’s scored by the CBO as a net deficit reducer because of tax hikes and Medicare cuts. We have seen examples in our past where promised Medicare cuts never materialized (Doc Fix). And I outlined one example in post #33 why the CBO probably underestimates future spending.

    The claim of deficit reduction is misleading. And in his interview with Bret Baier, President Obama said, “…if they vote against, then they’re going to be voting against health care reform and they’re going to be voting in favor of the status quo.”

    This was never our only feasible course of action for health reform. A no vote is not a vote for the status quo. We don’t have to push for a Western European form of socialized medicine to improve health care and health insurance. This legislation will most likely increase the deficit. And this process and its result has been an unmitigated disaster.

  • Braemar

    And so back to Brian137,

    To the heart of the question:
    Where is the tipping point, the point where you will not give up any more of yours to help another because you will not be able save yourself?

    I heard this tonight and I feel it is probably close to the center of this matter:
    Democrats see this as a moral issue and Republicans as an economic one. Ultimately well meaning help ends when you are in danger of doing great harm to yourself or others you care for.

    If this care plan saves money, (and I can not see how it can in this form) the Democrats will be proved correct. And if this costs money the country may fall into a bankruptcy from which it will not recover.

    Others believe, with me, that there are better ways to solve this problem.
    What have we learned from Oregon and Massachusetts?

    Time will tell us about this next experiment, if we have enough left.

  • tacitus

    We don’t have to push for a Western European form of socialized medicine to improve health care and health insurance.

    So, let’s see. We either move towards one of a number of systems that cover all citizens, are far cheaper, and (overall) have equal and sometimes even better outcomes than the US system, or…. what?

    We continue to tweak a system that is already failing millions of Americans, is rapidly pricing itself out of range of millions more, and continues to lock millions of workers into jobs, and forces millions of others to leave other jobs they like to find ones with decent and affordable health insurance. And all of this has never been successfully tried in any other country on the planet.

  • Brian

    @tacitus

    http://www.marginalrevolution.com/marginalrevolution/2009/11/what-should-we-do-instead-of-the-health-reform-bill.html

    My 3 favorite parts of Tyler Cowen’s proposal:

    6. Make an all-out attempt, comparable to the moon landing effort if need be, to introduce price transparency for medical services. This can be done.

    7. Preserve current HSAs. The Obama plan will tank them, yet HSAs, while sometimes overrated, do boost spending discipline. They also keep open some path of getting to the Singapore system in the future.

    9. Establish the principle that future extensions of coverage, as done through government, will be for catastrophic care only.

    Push for cost transparency in non-emergency care. HSAs give people some incentive to shop for better price and quality. Government mandates only require catastrophic policies (limiting the cost we all bear for uninsured ER visits).

  • http://tispaquin.blogspot.com Doug Watts

    Thanks Sean, as others have said, for a well-researched precis. With passion. As a native American, whose ancestors here can no longer be traced (we go back very far in Massachusetts), it is profoundly embarrassing to me that we still have not overcome the divisive elements who wish to separate us solely to keep us from attaining the basic social contract which existed in Western Europe 50-80 years ago. Since I am half Swedish, this makes me even more embarrassed. No excuses allowed.

  • http://tispaquin.blogspot.com Doug Watts

    “I claim it is wrong to take by force the fruits of one person’s labor and redistribute them to someone else, no matter how noble the ends. I guess that makes me an uncivilized idiot.”

    Yes, it does make you an uncivilized idiot. It’s called a circle of empathy. Liberals tend to make the circle very wide, even including animals, and in my case, sea lampreys. Conservatives tend to make the circle very small, sometimes excluding their own mother or sister. Only you can decide where you draw the circle. But in a civilized society, we are actually required to care about someone other than ourselves. This is the social contract. This is the Parable of the Good Samaritan. Or, as Chris Rock says, you don’t get credit for doing things you’re supposed to do.

  • metal

    the only thing that concerns me is whether I am four times below the poverty line or not

  • Peter Smith

    Carl Brannen, the health benefits of exercise are by now very well established. Given the obvious error in your first statement I find it hard to give your remaining statements any credence.

  • GuruOfChem

    What I object to in all of this wrangling is that nothing substantive was done to correct the underlying flaws in our healthcare model – Congress slapped on band-aids, covered a bunch more people without doing anything that guarantees that additional cost won’t be financed by middle class taxpayers, and did so in an entirely partisan, force majeure sort of way that should be nauseating to spectators of any party affiliation.

    Oh, and Mr. Watts – only an idiot would actually criticize another’s argument in such cavalier fashion. The point of a free society is to be ABLE to help others as you see fit and encourage others to do the same, not to be COMPELLED to do so by one’s government. Your “circle” may extend to sea lampreys, but you have no right, and neither does our government to tell me what my circle is, and I bitterly resent the excessive amount of money taken from me and my family that ends up funding the lifestyles of social parasites. We have let welfare and entitlement programs run so amok in this country that we make living perpetually on the public dole a possibility, perhaps even a lifestyle choice, and that level of parasitism is ultimately insupportable. And before you assume I’m a right wing nut job, let me also state that I am a Harvard educated science teacher in a Title I high school – I see the dark side of welfare every day. I have no problem helping those in genuine need, but we have allowed that assistance to become a crutch for far too many people who might otherwise be productive members of society.

  • jr

    gee – don’t quit your day job. This nonsense is why i come here less and less often.

  • Tom

    @ GuryOfChem
    I understand your issue with some entitelement programs. And that issue does not make you a right wing nut.
    Even though health care coverage is considered by most to be an entitlement program, it has a slightly different look and feel for me. Most people who don’t see doctors simply never had the money to save for that rainy day, are not able to afford the monthy costs of insurance, or are denied insurance for pre-existing conditions. This does not feel like help for “parasites”. It is an opportunity for someone to become productive. Or to have legitimate options to see their sick child see a doctor and receive appropriate medical care. I don’t think this HAS a dark side. No matter how many abuses you have seen for other entitlement programs.

    On other non reply related commentary:
    The problems with Heath Care are many. This bill only BEGINS to address but one or two of them. Is this the end of the road? No. We have more reform to go, especially on the insurance/expense end of things.
    Republicans were given EVERY opportunity to be a part the solution, and refused each and every time to genuinely engage in the process. Now they are angry this is being “pushed” through. Sounds like a child who doesn’t want his toy, but won’t let anyone else play with it either. the arguments that we are rushing to pass this is a sad ploy to stall initiative and just derail the process.
    The only thing I can give them points for is consistency and solidarity. Even if they would prefer to see our country sink and fail than to concede on some partisan positions.

  • Pingback: SphericalTechnologies.com » Blog Archive » Health-Care Reform Passed. So What Does It Mean?()

  • FReyes

    I for one was glued to my television for the numerous healthcare discussions between Republicans and Democrats in both the House and Senate, fulfilling the promise that President Obama made to be more transparent. It justified my vote for the man. I also reacted with glee when being told that I will be fined, if I refuse to obtain healthcare insurance. I am waiting for my mandate to purchase a government motors automobile, as my present vehicle is 7 years old.

    I guess I’m cynical because I thought my party would do a better job than the previous party in power has already done, or failed to do. This is more of the same, tired, political invectives thrown across both sides of “the Aisle”. What happened to insurance portability? Where is tort reform? I hope this healthcare bill helps those who really need it. I doubt it will do anymore than previous attempts to socialize business models that operate at or below the efficiency of private businesses. I think I’m going to register as an independent, because I no longer believe in the promises of either party.

  • Carl Brannen

    To attribute differences in lifespan to health care alone is silly. Russia has “free” health care and a 10-year shorter lifespan than the US and Europe. Lifespan is largely a function of your drinking, smoking, drug use, eating, unsafe sex habits, dangerous driving, inclination towards violence, religion, crime, lack of education, genetics, etc., health care is a minor input. The US is not comparable to Northern Europe in these things.

    And I don’t doubt that getting no exercise is bad for your health, however, the people I know who exercise to excess are constantly interacting with the medical profession to repair damage they’ve done to themselves. If you doubt this pick up a copy of “Sports Illustrated”. It’s not stuff that kills you; torn ligaments, etc., but it does put you in a doctor’s care. And it’s obvious to me that hurting yourself exercising is rough on your enjoyment of life.

    To imagine that the government will save money when it takes over an industry is naive in the extreme. The US government has never done anything efficiently in the past. Any money saved from reduced profits will be more than lost in waste and fraud. And it appears that this is going to be done with unfunded mandates to the States. Right now the States are broke; unlike the Feds they cannot print money. The result is likely to be even more severe squeezes on State spending. Hmm. One of the most convenient places to reduce State spending is in higher education.

    The whole situation reminds me of 1976 and Jimmy Carter.

  • Brian137

    Hi Braemar,
    Thank you for responding to my posts.

    Where is the tipping point, the point where you will not give up any more of yours to help another because you will not be able save yourself?

    You describe a dilemma which, quite frankly, I have never encountered personally. You seem to think of giving as a sacrifice and ask, “How much are you willing to sacrifice?” To a pretty good first approximation, I have never sacrificed anything for anyone – I give what I desire to give.

  • Sam Taylor

    Sean-

    As much as I enjoyed your lectures for the
    Teaching Company and the insights this blog provides into a world I don’t know much about, your statement “Asking healthy people to buy insurance will be a burden to them” does not inspire confidence in your analysis. Perhaps you would prefer a world where you could wait until your house was burning to buy fire insurance and expect someone to insure you at some rate for “average” risks you since you were suddenly willing to pay an insurance premium for the certain claim? It requires neither expertise in quantum physics or rocket science to do the math and calculate the economic cost you should pay for insurance or the adverse impact your sudden coverage at “average” rates will have on everyone else “in the pool”.

    Calculating age adjusted rates for insurance is fairly easy, setting socially/politically acceptable rates hard and letting people wait until they are sick to buy insurance, economically impossible unless as a society we want to pay all medical costs from general tax revenues.

    As one who spent over 50 years in the insurance industry including 20 years as an independent consultant/ banker/entrepreneur, I find it hard not to believe that a rapid transition to Medicare for all would be the optimum economic and social solution for our nation but one that given our history is neither feasible or practical. I consider the present legislation a major political accomplishment that provides the basis for actually coming to grips with a social/economic problem comparable in many ways to the “banking” problem that has cost and is costing our nation and many hard working , decent people dearly. Let’s hope we can take a major step in that direction as well, finding a path between the avaricious rent seekers and the puritanical utopians that might actually work.

  • Brian137

    I got timed-out on my last post. I continue.

    I heard this tonight and I feel it is probably close to the center of this matter:
    Democrats see this as a moral issue and Republicans as an economic one.

    Every Democrat is different from every other Democrat, and every Republican is different from every other Republican. Their points of view are numerous and varied.

    Anyway, I thank Braemar and so many others, with a special tip of the cap to Sean. I am enjoying your thoughtful comments. I am delighted that we can all discuss this without sniping at each other.

  • http://tispaquin.blogspot.com Doug Watts

    I bitterly resent the excessive amount of money taken from me and my family that ends up funding the lifestyles of social parasites.

    I accept the “bitter” part. The rest is the self-pitying whining of a kid told by his mother to share his toys with his sister.

  • jr

    You better get this straight. Congress is NOT granted the power to tell Americans what to do – but this HC bill tells you to buy insurance.
    A majority vote to tell you what to do is called TYRANNY OF THE MAJORITY.

    Get it ? IF they can tell you to buy insurance
    then they can tell you to buy Solar Panels or anything else some majority wants. The constitution does NOT delegate any such power.
    Thus – Conyers must be CENSURED and IMPEACHED.
    He and his pals are setting up a tyranny of the majority.

  • Brian137

    jr,
    Do you currently have medical insurance?

  • marvin thalenberg md

    Andy Borowitz suggests a teabagger sign which says Keep the Government out of Congress

    The government pays about 60% of health care costs now- and it has risen under the Republicans.

  • Braemar

    I personally pay for my health insurance(about $750/month) and a few hundred a month toward hubby’s medicare supplements and daughter’s college insurance, relatively cheap. I planned on that when I retired.

    I believe that Brian137, you have not yet understood the question. And I suppose since you are not in the situation yet, you are not planning ahead. So I will rephrase.
    Q: If you knew that you had a limited amount of resources to use to protect your own family/partners, someone you care greatly about, would you keep tighter control of those resources?

    Another rephrase of the same question: Will you feel well-being threatened if you need to protect yourself and lose control of your assets?

    I am one who likes to pay for my family and myself and do not want to trust the govt to take care of me. So I do not want to give up my resources to pay for others when I need to make sure my family is getting the lifesavig care or meds when needed.

    It seems that there is a growing idea that the govt has some stash of funds to use for all of us. The reality is lost about where that comes from. The free lunch is not free, just paid for by others.

    We are gathering a larger and larger group who have found out they can survive pretty well without much effort. Like pavlov’s dogs, we are training certain parts of the population to make do with govt welfare.

    Am I uncompassionate? No. Do I give to many charities and have people stay in my home at times of their need? Yes.

    I do not believe that large facets of society should feel that the govt owes them care or that others who were more successful through hard work should be expected to fund their needs. Not a smart idea. The nation will collapse under the weight of the pull of those being paid to wait for more handouts. This stifles entrepreneurship and small business start ups that are the engine for jobs to those paying taxes.

    Yes, the truly needy should be helped. The generations shoudl bnt be perpetuated in a living off the govt lifestyle. And yes it is happening.

  • Brian137

    Hi Braemar,
    Thank you for describing your feelings and your situation more fully. I respect and admire your genuine concern for yourself, your loved ones, and others in general. You seem like one of the people I hope health care reform can help. I believe the intent of the bill is to make things easier, not more difficult, for people in your situation. You raise the specter of unintended consequences doing more harm than good. That problem is certainly all too frequent. I wish you the best, and I am rooting for you.

  • Braemar

    My larger concern is that we (in the person of the federal govt) are moving in the direction of having more people voting for benefits than are paying for them. When we reach the tipping point, and we are close, the nation will collapse.

    How much of your weekly wage will you give to pay benefits you can not get while you work to pay for benefits to others! full circle

  • Brian137

    Braemar,
    I do not foresee a “collapse” of the American economy so much as a gradual (but perhaps steep) decline. Some of the reasons for this trend are beyond our control. Chance factors initially favored us, but the field is becoming more level. Many of the causes of this putative decline will be of our own collective creation, engendered by greed, callousness, and lack of foresight. I do not regard love, generosity and good will toward each other as our major problems.

  • bh

    CEO salaries are a perfect example of economic parasites. People on welfare or the dole may not contribute much to the economy, but nearly 100% of that money is pumped back into the economy as these people have very little savings. If CEOs are earning 400 times the average worker’s salary instead of 50 times, that’s 350 less full-time jobs in the economy. Sure, the CEO may spend his/her exorbitant salary and create jobs elsewhere, but it won’t be anywhere close to 350 due to wealth/income sheltering, i.e. the failure of trickle-down economics.

    If the income tax rate in this country were increased back to post-ww2 levels of 90% on the highest bracket, not only could the US finance a truly high quality single payer universal healthcare system, it could do so without suppressing GDP one bit, since, in terms of total GDP % on healthcare, the US already outspends every other nation on the planet.

  • Gary Ansorge

    61. Carl:

    You might want to actually READ that link you provided,,,

    “Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.”

    Their(Russian) health care has gone into the bucket. So, shorter life spans. They don’t have health care providers to anticipate health problems(preventive care).

    You used a very bad example.

    GAry 7

  • Jersey Bob

    Sean, I agree with your post, although for purposes of framing the issue, I wouldn’t call it “Obamacare”. That’s a derogatory term used by right-wing loonies who deny reality. It’s best not to use their language so as not to let them define the debate.

  • cnt. nukem

    Katharine (#1),let me guess who else you are scared of: Ann Coulter, Michelle Malkin, Glenn Beck… I am sure you are not scared of Islamic terrorists who really kill people , of Earth Liberation Front who bomb properties ,of the leftist anarchists in Texas who Molotov cocktailed the Texas Governor’s Mansion ( for which arrests have never been made). You are also not scared of socialist dictators who take over private properties and redistribute wealth as you see individual liberty to be not so important comparing to interests of the society.

    Was my guess correct?

  • cnt. nukem

    Re #31

    1.Sean: “Asking healthy people to buy insurance will be a burden to them.”

    First, it is not asking, it is mandating, something like in case of military draft. It is not even tax, it is mandate for way of conducting commerce and it oversteps constitutional limits for Federal Government. See it abolished by SCOTUS.

    2. “I think that’s the whole point of insurance — that you divvy up the risks among a group of people because “one never knows” who is going to get sick. And these group of people include healthy people.”

    In free society people can make decision to purchase insurance or not as they see fit. When individuals have no such freedom and the government decides for them, we have case of soft tyranny, something like in socialist Europe.But, people who are to busy thinking about benefits of society do not have time to think about such small thing as individual freedom. The paradox with that is as follows: when all citizens have less individual freedom the society as whole is not worth of living in.

  • Morgan-LynnGriggs Lamberth

    ent., nay! Those without insurance impose a burden on those who do. So we have to compel them to get it also. Some will still be a burden due to subsides for them. No longer will there be a free ride for those who could pay! You have matters backward, ma’am or sir!
    We thereby take away no ones essential freedom but give everyone freedom to be as well as possible as they exert themselves responsbily.
    Nay to any draft! There is no need unless in great danger as there is no need to draft for the police department.
    Reactonaries, bleat and weep!
    Spencer-Randism is dead!

  • jr

    #78 We shall find a list of things where those without something impose a burden
    on those who do – and then we will compel you. And we will do it with a majority
    vote.
    So I see that YOU want to determine what “essential freedom” consists of and
    for whom.

  • Andrew S

    It’s fascinating how the more comments there are in a thread, the less informed the commenters tend to be. Has anyone done a study of this?

  • http://fixerdave.blogspot.com Fixerdave

    Aren’t statistics grand?

    The US spends way more money, PER GDP, than Canada, yet Canadians, ON AVERAGE, live longer.

    In other words, it’s even worse than people are saying. If you have A LOT of money in the US, your health care is probably much better than Canada – and you’ll probably live longer. But, if you don’t have money in the US, then, well, you’ll probably die a lot earlier. Those averages hide the truth. In the US, it sucks big-time to be poor, or even middle-class.

    The US ruling elite have a vested interest in convincing as many Americans as they can that “they” are in the “a lot of money” category that gets better healthcare, even though they’re not. They throw out all these anecdotal stories, Canadians have to wait, they don’t have equipment, making this system look bad – and yet it’s not. I know, I live here – there would be riots in the streets if our politicians tried to change our system. But, you’ll always find that story where an American got served right away, while the Canadian had to wait. I bet that American had A LOT more money than you do. All that US percentage of GDP… it’s probably not being spent on you.

    Oh, and all that “not paying taxes” garbage. You are paying, big time. Instead of taxing you, they’re borrowing money, which will make your paycheck worth less. One way or another, YOU are paying for all that amazing high-priced US healthcare, that you (you being the average US citizen) can’t benefit from. Somehow, you’ve all been convinced you’re above average, ‘aint statistics grand.

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Cosmic Variance

Random samplings from a universe of ideas.

About Sean Carroll

Sean Carroll is a Senior Research Associate in the Department of Physics at the California Institute of Technology. His research interests include theoretical aspects of cosmology, field theory, and gravitation. His most recent book is The Particle at the End of the Universe, about the Large Hadron Collider and the search for the Higgs boson. Here are some of his favorite blog posts, home page, and email: carroll [at] cosmicvariance.com .

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